Can anticoagulation be used safely and effectively to manage venous thromboembolism in patients with primary and metastatic brain tumors?
Anticoagulation is generally safe and effective for managing VTE in patients with brain tumors, and is preferred over mechanical approaches like vena cava filters despite concerns for intracranial bleeding.
Venous thromboembolism occurs commonly throughout the clinical course of patients with brain tumors. A number of hemostatic and clinical factors contribute to this hypercoagulable state. Concern over the possibility of intracranial bleeding has limited the use of anticoagulation in this population. However, mechanical approaches such as vena cava filters have high complication and treatment failure rates in patients with intracranial malignancies. In addition, the available data suggest that anticoagulation can be used safely and effectively in most of these patients. Patients with thrombocytopenia, recent neurosurgery, and tumor types prone to bleeding require special consideration. When intracranial hemorrhage does occur, it is often due to overanticoagulation, requiring prompt anticoagulation reversal and neurosurgical consultation.
Gerber et al. (Wed,) studied this question.